Stress can occur before, during and after surgery. This happens because the body is in ‘fight or flight’ response, and trying to heal itself. As the body responds to stress, it releases hormones that may make it difficult to regulate blood glucose. Diabetes medications or dosages may need to be adjusted to control blood glucose.

Fortunately, preparing yourself well can reduce the stress. Take action now to improve both your safety and recovery time. Know what to expect during your appointments with your doctor, surgeon or diabetes educator. Keep checklists to help you to stay informed and prepared. Work with your health care team to make needed changes before, during and after surgery.

Meet with your health care providers

A physical exam and other tests may be required before surgery. Your doctor, surgeon or anesthesiologist (the doctor who gives you medication to relax or sleep during your surgery) will collect important medical information. This may include:

current and previous medical conditions, including details about and complications related to diabetes
previous medical procedures or surgeries
food or drug allergies
a list of prescribed medications, including type, strength, dosage and time medications are taken
a record of non-prescribed and OTC (over-the-counter) medications, including vitamins, herbal remedies, and medications for pain
your current meal plan
the name and contact information of your advocate (a family member or support person).

Begin by creating your own record of these important medical details. This helps ensure that the information you give is consistent and accurate. You may also want to give a copy to your advocate.

Control your blood glucose

Studies show that people with well-controlled diabetes have fewer problems throughout their surgery experience. If necessary, meet with your doctor or diabetes educator and develop a plan to get your blood glucose under control before the surgery.

Good blood glucose control reduces the risk of high and low blood glucose levels or complications of surgery. It also makes infection less likely, promotes wound healing, and enhances recovery times.

If you use diabetes medication, it is especially important to test your blood glucose levels regularly – before, during and after surgery. Ask your doctor or diabetes educator when and how often you should check your blood glucose levels. Review the results together, and decide whether diet, activity and medication changes are needed.

Consider talking to your surgeon about scheduling your surgery for early morning. This timing helps reduce the risk of a high or low blood glucose reaction.

Dietary guidelines

With certain types of surgeries, you may need to restrict your diet. Talk to your doctor or dietitian to see whether changes are needed. For instance, if you are preparing for a major procedure such as heart surgery, you might need a low sodium, low fat and controlled carbohydrate diet.

Some surgeries require general anesthesia, meaning you will sleep through the procedure. If this is the case, be sure not to eat or drink anything after midnight the evening before your surgery.

Minor procedures, such as colonoscopy, have special guidelines. Your doctor will provide these details in advance. Often, procedures require that you can only consume clear fluids on the day before and up to a few hours beforehand. During this time, you may be directed to consume liquids that contain sugar. This can help you get the proper amount of dietary carbohydrates. Clear fluid diets should include about 200 grams of carbohydrate, spread throughout the day. Appropriate fluids include fruit juices like apple, clear sodas, honey, regular (not sugar-free) Jell-O, tea or coffee without milk or cream, and ice pops or popsicles with sugar. Sugar-free clear fluids are not appropriate for people with diabetes who are preparing for surgery. Avoid fluids with red, blue or purple food dyes. Remember that clear fluid diets are not nutritionally complete, and should only be used for a short time.

Achieving a healthy weight is key to managing type 2 diabetes. However, dieting as you prepare for surgery may not allow you to get the nutrition needed for proper healing. Good nutrition promotes healing and lowers the risk of complications after surgery.

Weight loss sometimes occurs after surgery. Lack of appetite and nausea are common. If this is true for you, try the following tips.

Eat five to six smaller meals throughout the day.
Drink enough fluid, including water. If you do not get enough liquids, nausea may be worse. Try to have one cup every hour while awake, and sip fluids between meals. Fluid restrictions are sometimes needed after surgery, so check with your doctor.
Liquid nutritional supplements may help you to get more energy, vitamins and minerals during your recovery.
Eat dry crackers or toast first thing in the morning to help with nausea.
Smelling citrus fruits like lemons, oranges or grapefruit may help spur your appetite.
Try cold foods rather than hot.
Stand up slowly and do not lie down for one hour after eating.

If your surgery is a few months away, use the time to plan well-balanced meals for your recovery. Prepare and freeze meals like soups and casseroles. Small snacks that freeze well include low fat and low sugar muffins and breads.

Medications – what to start, continue or stop

Before the procedure, be sure to discuss the medications that you are taking with your doctor or surgeon. You may need to stop taking some types of diabetes and over-the-counter (OTC) medications, vitamins and herbal supplements prior to surgery. Depending on the medication, this may be 24 hours to two weeks before surgery. OTC medications like ASA (Aspirin), ibuprofen, and herbal supplements may interfere with how your blood clots. Specific instructions on diabetic medication management should be obtained from your diabetes care provider.

Ask your doctor or surgeon which medications to take on the morning of your surgery. You may be advised to continue taking certain diabetes, blood pressure or heart medications. Take your medications with a small sip of water.

After surgery, you may find that the stress of surgery and the changes to your physical activity and eating pattern require changes to your diabetes management. For instance, if you have less appetite and are eating very little after surgery, your diabetes medications may require adjustment.

Ask your doctor or surgeon whether any new medications will be needed after the surgery. This might include medication for pain or nausea, stool softeners or another medication. Fill the prescriptions before surgery, so that the medication is available when you need it.

Packing for your hospital stay

Take the following items with you to the hospital:

your medical history, medication list, and the meal plan that you follow at home
diabetes medications
a blood glucose meter, lancing device and lancets, so that you can test your own blood glucose
fast acting glucose, in case your blood glucose becomes too low and you require treatment
sturdy slip-on slippers or shoes
lotion for your feet (especially heels), knees and elbows
warm, loose fitting socks to keep your feet warm if you have problems with circulation
personal hygiene items like a toothbrush, toothpaste, shampoo, and tissue.

Discharge from hospital

Before you leave the hospital, ask for instructions about:

any changes to your medications, or new medications or treatments
the correct meal plans and activity levels for when you return home
how often to check your blood glucose, and the expected levels
signs to watch for once you leave, and who and when to call if you have a medical emergency
booking a follow up appointment with your doctor or diabetes health care team to review diabetes management and the progress of your healing.

Surgery can be stressful. However, knowing how to prepare for surgery, and having necessary information on hand, helps reduce fear and uncertainty. Proper blood glucose control and nutrition are needed for a quick and healthy recovery. Talk to your doctor or diabetes educator for help in managing diabetes and preparing for surgery.

Reducing the Stress of Surgery Know what to expect and plan ahead

If you have an upcoming surgery, just thinking about it may create feelings of fear and uncertainty. However, this physical and emotional stress can affect your health, especially if you have diabetes.